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EAU 2018

EAU 2018: Socioeconomic Status and Diagnosis, Treatment, and Mortality in Men with Prostate Cancer: A Nationwide Population-Based Study

Copenhagen, Denmark (UroToday.com)  Evidence from a variety of settings indicate that patients with higher socioeconomic status have better prostate cancer-specific outcomes. This has also been shown for several cancers in Sweden, a country with a tax-financed health care system aiming to provide care on equal terms to all residents. Dr. Ventimiglia and colleagues presented results of their nationwide population-based study examining the association between socioeconomic status and patterns of care and mortality in men with prostate cancer.

For this study, the association between income, educational level, marital status and diagnostics and treatment, and prostate and all-cause mortality was assessed in 74,643 men diagnosed with prostate cancer in Sweden between 2007 and 2014. Logistic regression models were applied to data from the National Prostate Cancer Register and a number of other health care registries and demographic databases in the Prostate Cancer Data Base Sweden (PCBaSe).

The authors found that on multivariable analysis, men with highest income had the highest probability of a screen-detected prostate cancer [top vs bottom quartile of income, OR 1.60 (95%CI 1.45-1.77)] and shorter waiting time to prostatectomy [waiting time more than 3 months, OR 0.77 (0.69-0.86)]. High incomes patients also had a higher probability of receipt of curative treatment for intermediate or high-risk cancer [OR 1.77, 95%CI 1.61-1.95) and lower risk of positive surgical margins at prostatectomy [OR 0.80 95%CI 0.71-0.90]. A similar, but weaker pattern was observed for educational level. There were very small differences in prostate cancer mortality according to income, however all-cause mortality was more than twice as high in men 65 years and older in the bottom vs top quartile of income (30% vs 12% p<0.001).

Dr. Ventimiglia concluded that men with high socioeconomic status received modestly, but statistically significantly better prostate cancer care in Sweden despite an equal access tax-financed health care system. Even in universal health care systems, disparities exist and deserve attention for future research endeavors.


Presented by: Eugenio Ventimiglia, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Universita Vita-Salute, San Raffaele, Milan, Italy

Co-Authors: Tomic K, David R, Lambe M, Stattin P

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark